Healthcare Provider Details

I. General information

NPI: 1508962390
Provider Name (Legal Business Name): REBECCA ELAINE HUTCHINS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 08/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 N 79TH ST SUITE 101
LONGMONT CO
80503-7042
US

IV. Provider business mailing address

6800 N 79TH ST SUITE 101
LONGMONT CO
80503-7042
US

V. Phone/Fax

Practice location:
  • Phone: 303-652-0505
  • Fax: 303-652-0606
Mailing address:
  • Phone: 303-652-0505
  • Fax: 303-652-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1254
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number1254
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: